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Aim: This study proposes to investigate the influence of various surgical guide designs on the generation temperature in the cortical and cancellous regions of the osteotomy site. The working hypothesis was that open guides are more efficacious in controlling excessive heat generation in cortical and cancellous areas. Materials and Methods: Implant osteotomy was performed on specimens simulating D3 bone density using surgical guides produced with three different designs: an open guide, a guide with an external cooling channel, and a closed guide. Temperature increases occurring in the cortical layer from a depth of 2 mm and in the cancellous layer from a depth of 10 mm were measured with type K thermocouples. Results: Temperature averages recorded from a depth of 2 mm during osteotomy show statistically significant differences between groups (p =.003). The temperature rise in the group using a closed surgical guide was significantly higher than in the groups using an open surgical guide and a surgical guide with an external cooling channel on the cortical layer, while the temperature increase did not show any significant difference in both cortical and cancellous layers between the open guide and guide with external cooling channel. Temperature averages recorded from a depth of 10 mm do not show statistically significant differences between groups (p =.054). Conclusion: Using open surgical guides or surgical guides with external cooling channels among the guided surgical systems is a more reliable way to keep the thermal increase under control. [ABSTRACT FROM AUTHOR]

Background and Objectives: Curettage is the removal of a tumor from the bone while preserving the surrounding healthy cortical bone, and is associated with higher rates of local recurrence. To lower these rates, curettage should be combined with local adjuvants, although their use is associated with damage to nearby healthy bone. Objective: The purpose of this analysis is to determine the effect of local adjuvants on cortical porcine bone by using micro-computed tomography (micro-CT) along with histological and mechanical examination. Methods: Local adjuvants were applied to porcine specimens under defined conditions. To assess changes in bone mineral density (BMD), a micro-CT scan was used. The pixel gray values of the volume of interest (VOI) were evaluated per specimen and converted to BMD values. The Vickers hardness test was employed to assess bone hardness (HV). The depth of necrosis was measured histologically using hematoxylin and eosin-stained tissue sections. Results: A noticeable change in BMD was observed on the argon beam coagulation (ABC) sample. Comparable hardness values were measured on samples following electrocautery and ABC, and lowering of bone hardness was obtained in the case of liquid nitrogen. Extensive induced depth of necrosis was registered in the specimen treated with liquid nitrogen. Conclusion: This study determined the effect of local adjuvants on cortical bone by using micro-CT along with histological and mechanical examination. Phenolization and liquid nitrogen application caused a decrease in bone hardness. The bone density was affected in the range of single-digit percentage values. Liquid nitrogen induced extensive depth of necrosis with a wide variance of values. [ABSTRACT FROM AUTHOR]

Introduction: Avascular necrosis (AVN) is a rare progressive degenerative disease leading to bone and joint destruction. Patients often require surgical intervention. Femoral AVN is the most common anatomical location. Hyperbaric oxygen treatment (HBOT) has been shown to be effective in AVN. We present data collected from one centre over a 30-year period and compare the results with other published data. Methods: A retrospective chart review of all patients receiving HBOT for AVN at Fremantle and Fiona Stanley Hospitals since 1989 was performed. The primary outcome was radiological appearance using the Steinberg score, with secondary outcomes being subjective improvement, the need for joint replacement surgery and rates of complications. Results: Twenty-one joints in 14 patients (14 femoral heads and seven femoral condyles) were treated with HBOT since 1989. Two patients were excluded. Within the femoral head group, nine of the 14 joints (64%) had stable or improved magnetic resonance imaging (MRI) scans post treatment and at six months (minimum); 10 joints (71%) had good outcomes subjectively, three joints required surgical intervention, and three patients developed mild aural barotrauma. Within the femoral condyle group, all five joints had stable or improved post-treatment MRI scans (four had visible improvement in oedema and/or chondral stability), four joints reported good outcomes subjectively, none of the patients required surgical intervention (follow-up > six months). Conclusions: This single centre retrospective study observed prevention of disease progression in femoral AVN with the use of HBOT, comparable to other published studies. This adds to the body of evidence that HBOT may have a significant role in the treatment of femoral AVN. [ABSTRACT FROM AUTHOR]

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Background: Primary bone lymphoma (PBL) is a rare form of extra nodal non-Hodgkin’s lymphoma (NHL). Case description: We describe a 39-year-old-male with no medical history who presented with unilateral facial swelling following a tooth extraction. Initial diagnoses after various presentations over the course of three weeks, based on inflammatory and infectious aetiologies. However, the patient was ultimately diagnosed with diffuse large B-cell lymphoma. Discussion: Symptoms of PBL are very similar to inflammatory and infectious diseases of the bone, such as osteomyelitis or osteonecrosis. Clinical features of PBL involving the head and neck include persistent jaw pain, tooth mobility secondary to extensive destruction of bone, and in advanced cases, lip numbness and swelling. On examination it may present as an exposed necrotic bone with surrounding soft tissue oedema. Misdiagnosis of these lesions as an infectious or inflammatory aetiology may lead to an unnecessary delay in lymphoma treatment, and subsequently worsen the prognosis if caught at a later stage. Therefore, any concerning lesion, especially in the oral cavity, must be subjected to early histopathological evaluation to differentiate PBL from osteomyelitis and/or osteonecrosis. Conclusion: This case report highlights the importance of an early histopathological evaluation to prevent delay in the diagnosis of primary bone lymphomas.

Medication‐related osteonecrosis of the jaws (MRONJ) is a serious debilitating disease resulting from long‐term treatment with Antiresorptive drugs such as Bisphosphonates or Denosumab, which significantly affects patients' quality of life. A 43‐year‐old female patient with stage 4 breast cancer and treated with Zoledronic Acid for bone metastases was referred to the Department of Oral Medicine at the Faculty of Dentistry, Damascus University. The main complaint was pain in the right maxilla. Intraoral examination showed an exposure of necrotic bone in the right maxillary region with presence of purulent exudate. The treatment plan was discussed with the patient. Treatment included resection of all necrotic bone and application of Advanced platelet‐rich fibrin (A‐PRF) clots and membranes. Follow‐up and outcome were conducted by clinical measures to assess healing and recurrence (6‐month follow‐up). Topical treatment with A‐PRF demonstrated a reduction in pain and resulted in complete wound healing within 30 days. A‐PRF stimulates the release of growth factors and chemotaxis involved in tissue repair mechanisms. This method seemed to be effective in the treatment of MRONJ. [ABSTRACT FROM AUTHOR]

IntroductionArtisanal diving fishermen in Yucatán, Mexico have high rates of decompression sickness as a result of frequently unsafe diving practices with surface supplied compressed air. In this study, we investigated the prevalence of dysbaric osteonecrosis (DON), a type of avascular necrosis, in the most susceptible joints in a cohort of these fishermen.MethodsWe performed radiographs of bilateral shoulders, hips, and knees of 39 fishermen in Mexico and surveyed them about their medical and diving histories. We performed pairwise correlations to examine if the fishermen's diving behaviours affected the numbers of joints with DON.ResultsThe radiographs revealed Grade II or higher DON in 30/39 (76.9%) of the fishermen. Twenty-two of 39 fishermen (56.4%) had at least two affected joints. The number of joints with DON positively correlates with the lifetime maximum diving depth and average bottom time.ConclusionsThese findings represent among the highest prevalence rates of DON in divers and reflect the wide-spread scale of decompression sickness among these fishermen. Through this work, we hope to further educate the fishermen on the sequelae of their diving with the aim of improving their diving safety.

Pancreatitis, panniculitis, and polyarthralgia (PPP) syndrome is a rare complication of chronic pancreatitis and occurs due to leakage of pancreatic enzymes in the systemic vasculature. This enzyme leakage leads to multiple manifestations such as polyarthralgia, panniculitis, and bone necrosis due to tissue autodigestion.The inciting pancreatic pathology may be masked, and the presentation may be due to one of the systemic consequences of enzyme leakage, which can present as a diagnostic challenge for clinicians. Here we present a patient who presented with nodular lesions and bone necrosis, and was found to have PPP syndrome. Therefore, a proper understanding of pathophysiology and radiology findings can help with prompt diagnosis and early exploration of management options.

Introduction: Rhinomaxillary Mucormycosis (RMM) is a condition peculiarly seen as post-COVID-19 opportunistic infections with Maxillary Sinus Disease and Osteomyelitis (MSDO). The open method of debridement and closed method are two types of surgical modalities available. There is no scoring method for this infection in maxilla. This paper aims to study the clinical and CT-based outcome of open versus closed surgery of MSDO in post-COVID-19 RMM and propose a new scoring method to evaluate the disease severity, progression as well as recovery. Material and Methods: Symptomatic cases of RMM (n = 17) with a history of closed surgical treatment were enrolled for this prospective clinical study. These cases were then treated by medicinal and open surgical method. The clinical and CT scan outcomes were compared by proposed new scoring method. The CT-based score for Maxillary Sinus Disease (MSD) and Maxillary Osteomyelitis (MO) from pre-FESS (CT1), Post-FESS (Preoperative, CT2), and Post-operative (CT3) were compared for both right and left sides. One-way ANOVA test and post HOC tests were used for statistical evaluation. Conclusion: The open method of maxillary sinus surgery has given significant improvement in the treatment of RMM already treated by a closed endoscopic approach. [ABSTRACT FROM AUTHOR]

Medication-related osteonecrosis of the jaw (MRONJ) is a relatively common pathology occurring in around 5% of patients taking bisphosphate and other antiresorptive or anti-angiogenic medications. Despite the efforts, as of today there is still no consensus on its management. In this case report, the successful management of stage II MRONJ was performed for an eighty-three-year-old female patient suffering from pain and alteration in her normal oral functions (swallowing and phonation). The treatment consisted of three sessions of photobiomodulation therapy (PBM), followed by minimal surgical intervention and three other sessions of PBM. PBM was applied on the sites of osteonecrosis with the follow parameters: 4 J/cm2; a power of 50 mW; 8 mm applicator diameter; a continuous contact mode. Irradiation was performed on three points, including the vestibular, occlusal and lingual parts of each of the bone exposure areas. Each point was irradiated for 40 s, and, in total, nine points were made per session, and nine sessions were conducted. To assess the pain, a visual analogue scale was used in which zero represented no pain at all and ten represented the greatest pain. At the first session and before any intervention, the patient stated that her pain was 8 out of 10. At the end of the treatment, a significant reduction in VAS was noted (2/10) and, clinically, a healing of the soft tissue in the previously exposed bone was observed. This case report suggests that the combination of PBM with surgical intervention is promising in the management of MRONJ. [ABSTRACT FROM AUTHOR]

Arsenic trioxide used in endodontic treatments has been shown to cause severe damages to surrounding bone and periodontal tissues. This report describes a case of alveolar osteomyelitis triggered by arsenic trioxide pulp devitalization and associated with mycotic infestation. Following clinical and radiological examinations, the concerned tooth was extracted, bone sequestrum was removed and granulation tissue was debrided. Histopathological biopsy examination, stained with hematoxylin/eosin, Grocott's silver methenamine and periodic acid-Schiff, confirmed the diagnosis of chemical osteomyelitis associated with fungal infestation. Six months postoperatively, normal bone healing was observed. [ABSTRACT FROM AUTHOR]

Many endodontically treated teeth require a post to improve the retention of the coronal restoration, which necessitates removal of the coronal part of the gutta-percha from the canal by thermal method, among other techniques. However, this technique carries the risk of heat conduction to the attachment unit of the periodontium and infliction of permanent damage especially in cases where the remaining root's dentin walls are thin. The overall objective of this article is to report on the clinical manifestations, histologic description, and periodontal management of three cases of heat-induced damage following thermal removal of gutta-percha. [ABSTRACT FROM AUTHOR]

Case: A 17-year-old adolescent boy complained of plantar pain at the first metatarsal 2 months after a catfish spine injury. Imaging was consistent with a retained foreign body, and surrounding osteolysis was concerning for osteomyelitis. He underwent surgical debridement and was found to have inflammation and necrosis, apparently caused by catfish spine venom. Conclusion: Although osteolytic lesions are commonly attributed to infection or tumor, in the situation of venomous injuries, osteolysis can be a sequela of the severe local inflammatory reaction due to the toxins. Debridement is vital to remove the offending agent and the local toxins from the venom. [ABSTRACT FROM AUTHOR]

Ten Wistar males rats were used to induce experimental periodontitis by placing a 5-0 cotton thread ligature at the base of the first superior molar on the left side. Before this phase, the molar went through the process of scaling, rooting and planning. Soft movements of the molar were realized for creating an accumulation of plaque by flattening and by resulting the displacement of the gingival tissue, thus provoking an inflammatory response. After 7 days the ligatures were removed in all ten rats. After 14 days, results obtained showed gross aspects of periodontitis and microscopical lesions as well, installed in the periodontium. Microscopically, an inflammatory response with bone necrosis and alveolar bone loss was observed. The aim of this study is to test an experimental protocol of periodontitis confirming the presence of this pathology by gross aspects and also histopathological aspects. In conclusion, the tested procedure is able to provide all the key biological elements present in periodontal disease, whereas representing the adequate features for biomaterial testing domain.

Introduction. Hyperbaric oxygen therapy is a treatment option for an increasing number of conditions. The aim of this study was to assess its therapeutic effects in femoral condylar necrosis as well as in normal tissue using hyperspectral imaging. Material and method. A 47-year-old female patient diagnosed with avascular necrosis of the medial femoral condyle was included in this study. The patient received hyperbaric oxygen therapy for two consecutive days (the first day: three stages of 30 min each, separated by two breaks of 5 min at pO2 = 2 ATA; the second day: three stages of 30 min each, separated by two breaks of 5 min at pO2 = 2.4 ATA). The effects of hyperbaric oxygen therapy on the affected area (patient’s knee) and normal (patient’s hand) tissues oxygenation were assessed before and after each treatment session using hyperspectral imaging. Results and discussions. The results showed that hyperspectral imaging is quite good for monitoring the hyperbaric oxygen therapy efficacy in affected areas, even with deep tissue problems. Conclusions. In conclusion, the hyperspectral imaging-based approach for monitoring hyperbaric oxygen therapy could support physicians in extracting prognostic information and making the right treatment decisions.

Introduction Paraformaldehyde has been used in endodontics when effective anaesthesia could not be achieved. However, this agent has many adverse effects including gingival, bone necrosis, osteomyelitis and allergy on account of systemic exposure. Therefore, the use of pastes containing paraformaldehyde should be avoided in contemporary dental practice. Objective The aim of this case report was to present the application of platelet-rich fibrin(PRF) in combination with a coronally advanced flap in the treatment of gingival and bone necrosis associated with paraformaldehyde containing devitalizing paste toxicity. PRF is an autogenous resorbable membrane composed of platelets, cytokines, leukocytes and growth factors. Results and conclusions Four weeks following burgery, the wound was completely healed with epithelial cells covering the interdental crater. On the basis of literature and of the present case, it can be stated that the use of PRF significantly reduces postoperative pain and promotes tissue healing.

Medication-related osteonecrosis of the jaw (MRONJ) is a relatively common pathology occurring in around 5% of patients taking bisphosphate and other antiresorptive or anti-angiogenic medications. Despite the efforts, as of today there is still no consensus on its management. In this case report, the successful management of stage II MRONJ was performed for an eighty-three-year-old female patient suffering from pain and alteration in her normal oral functions (swallowing and phonation). The treatment consisted of three sessions of photobiomodulation therapy (PBM), followed by minimal surgical intervention and three other sessions of PBM. PBM was applied on the sites of osteonecrosis with the follow parameters: 4 J/cm2; a power of 50 mW; 8 mm applicator diameter; a continuous contact mode. Irradiation was performed on three points, including the vestibular, occlusal and lingual parts of each of the bone exposure areas. Each point was irradiated for 40 s, and, in total, nine points were made per session, and nine sessions were conducted. To assess the pain, a visual analogue scale was used in which zero represented no pain at all and ten represented the greatest pain. At the first session and before any intervention, the patient stated that her pain was 8 out of 10. At the end of the treatment, a significant reduction in VAS was noted (2/10) and, clinically, a healing of the soft tissue in the previously exposed bone was observed. This case report suggests that the combination of PBM with surgical intervention is promising in the management of MRONJ.

Sodium hypochlorite (NaOCl) is a strong antiseptic agent that is usually used as endodontic irrigant for dissolving organic parts of pulp and dentin and neutralizing toxic products. However, the use of sodium hypochlorite may cause destruction of blood vessels, soft tissues and bone necrosis if extruded into the periapical region. Urgent treatment of the NaOCl accident should be oriented on pain relief, infection control and recovery. This paper shows a case of periradicular tissue necrosis after accidental extrusion on NaOCl through fausse route of right maxillary canine, and complete tissue regeneration after surgical debridement and bone augmentation with addition of platelet rich fibrin (PRF) that occurred in a 53-year old patient at the dental clinic of Faculty of Dentistry in Pancevo.

Many of medicaments used historically in root canal treatment have been shown to be cytotoxic. Paraformaldehid agents (such as Toxavit and Depulpin) are used to devitalize inflamed pulp when local anesthesia is ineffective. The misuse of pulp devitalizing agents may cause damage to gingiva and alveolar bone. This case report demonstrates complications arising after application of paraformaldehyde containing paste, necrosis of the gingiva and alveolar cortical bone, which resulted in great loss of supporting bone. Surgical intervention was required wherein necrotic bone was removed and bone defect was filled with xenograft of bovine origin. After three months endodontic treatment was performed. After the treatment, the patient's complaints were resolved. The use of paraformaldehyde-based agents during endodontic therapy requires special caution.

During this presentation, a variety of class effects were reviewed by their differing effects on bone, including inhibition of endochondral ossification, inhibition of the growth hormone-insulin-like growth factor 1 axis, promotion of bone formation, inhibition of bone formation, abnormal bone formation, promotion of bone resorption, inhibition of bone resorption, and bone necrosis. [ABSTRACT FROM AUTHOR]

Introduction. Hyperbaric oxygen therapy is a treatment option for an increasing number of conditions. The aim of this study was to assess its therapeutic effects in femoral condylar necrosis as well as in normal tissue using hyperspectral imaging. Material and method. A 47-year-old female patient diagnosed with avascular necrosis of the medial femoral condyle was included in this study. The patient received hyperbaric oxygen therapy for two consecutive days (the first day: three stages of 30 min each, separated by two breaks of 5 min at pO2 = 2 ATA; the second day: three stages of 30 min each, separated by two breaks of 5 min at pO2 = 2.4 ATA). The effects of hyperbaric oxygen therapy on the affected area (patient's knee) and normal (patient's hand) tissues oxygenation were assessed before and after each treatment session using hyperspectral imaging. Results and discussions. The results showed that hyperspectral imaging is quite good for monitoring the hyperbaric oxygen therapy efficacy in affected areas, even with deep tissue problems. Conclusions. In conclusion, the hyperspectral imaging-based approach for monitoring hyperbaric oxygen therapy could support physicians in extracting prognostic information and making the right treatment decisions. [ABSTRACT FROM AUTHOR]

Introduction. Paraformaldehyde has been used in endodontics when effective anaesthesia could not be achieved. However, this agent has many adverse effects including gingival, bone necrosis, osteomyelitis and allergy on account of systemic exposure. Therefore, the use of pastes containing paraformaldehyde should be avoided in contemporary dental practice. Objective. The aim of this case report was to present the application of platelet-rich fibrin(PRF) in combination with a coronally advanced flap in the treatment of gingival and bone necrosis associated with paraformaldehyde containing devitalizing paste toxicity. PRF is an autogenous resorbable membrane composed of platelets, cytokines, leukocytes and growth factors. Results and conclusions. Four weeks following burgery, the wound was completely healed with epithelial cells covering the interdental crater. On the basis of literature and of the present case, it can be stated that the use of PRF significantly reduces postoperative pain and promotes tissue healing. [ABSTRACT FROM AUTHOR]

Osteonecrosis (ON) is a clinical entity characterized by a pattern of cell death and complex process of bone resorption and formation. Studies related to ON have largely focused on certain anatomical sites; however, the evidence on vertebral body ON (VBON) is largely inconsistent and fragmented. The aim of this study was to clarify the pathophysiology, risk factors, imaging findings, and available treatment modalities for VBON. A systematic review of the relevant articles published in English was performed using PubMed, Embase, Medline, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases. A total of 81 articles were included in this study. Three main topics about VBON were identified: (1) pathophysiology and risk factors, (2) diagnosis, and (3) treatment. Forty-five studies were based on the pathophysiology, 52 on diagnosis, and 38 on the treatment options for VBON. The literature on VBON was limited and mainly focused on post-traumatic cases with a considerable overlap with nonunion and pseudoarthrosis.

External skeletal fixation has been used for the management of fractures of many types of bone. The use of polymeric free-form connecting bars in external fixators has become widely used in veterinary orthopaedics because of its versatile forms of frame construction and its relative low costs. Determining thermal-transfer to trans fixation pins during polymerisation of poly(methyl methacrylate) and epoxy putty polymers used for free-form external skeletal fixation connecting bars is important for avoiding temperatures of more than 47 °C, which would cause thermal soft tissue injury. Therefore, thermal transfer to trans fixation pins was measured in vitro during the polymerisation phase of these polymers. We used trocar-pointed pins of different diameters that punctured one wall of a connecting tube, resulting in the tip of the trocar-pointed pin reaching the centre of the tube. The FLUKE® VT02 infrared digital camera was then used to measure heat transfer to the pins at 1 or 2 cm from poly(methyl methacrylate) or epoxy putty. The polymerisation temperatures of these polymers yield a potentially dangerous level of heat for soft and hard tissue. This was observed in almost all the experimental conditions tested. On the other hand, epoxy putty transfer to the pins did not cause the temperature to reach 47 °C at any time or in any of the setups examined. Poly(methyl methacrylate) did reach more than 47 °C and remained at that level for more than 1 min at 1 cm from the polymer. This acrylate exhibited polymerisation temperatures higher than epoxy and its heat transfer to the pins was potentially dangerous if used at less than 1 cm from soft or hard tissue.

As drilling generates substantial bone thermomechanical damage due to inappropriate cutting tool selection, researchers have proposed various approaches to mitigate this problem. Among these, improving the drill bit design is one of the most feasible and economical solutions. The theory and applications in drill design have been progressing, and research has been published in various fields. However, pieces of information on drill design are dispersed, and no comprehensive review paper focusing on this topic. Systemizing this information is crucial and, therefore, the impetus of this review. Here, we review not only the state-of-the-art in drill bit designs—advances in surgical drill bit design—but also the influences of each drill bit geometries on bone damage. Also, this work provides future directions for this topic and guidelines for designing an improved surgical drill bit. The information in this paper would be useful as a one-stop document for clinicians, engineers, and researchers who require information related to the tool design in bone drilling surgery. [ABSTRACT FROM AUTHOR]

• A simple analytical model allows predicting temperature rise during bone drilling, as a function of spindle speed. • The lateral friction during bone drilling plays a significant role in the duration of the temperature increase inside bone. • It is unsuitable to consider bone as an infinite medium inside thermal models, to reproduce temperature rise during drilling.. Predicting the bone thermal response in a surgical operation remains a major challenge. In the previous works, metal machining theory has frequently been used to predict bone temperature in drilling process. However, several experimental studies demonstrate that the chip formation process is very complex compared to metal cutting. In the present study, a simplified analytical model based on the moving heat source approach combined with the method of image sources is developed. The heat source due to the drill-bit tip was supposed to be proportional to the cutting energy. The friction at the tool-hole contact was also considered. An experimental study was performed on fresh femur pig bone for cutting speeds from 2 to 20 m/min. Temperature rise, drilling forces and bone volume fraction were measured. The experimental validation showed that the model reproduces satisfactorily the increase in temperature up to the maximum value while it overestimates the temperature during the cooling stage. A parametric study (thermal boundary conditions, lateral friction) was also performed. From the predicted results, it appears that the model can be improved by considering the effects of the bone volume fraction which can present a significant variation in the bone sample. [ABSTRACT FROM AUTHOR]

Introduction: The treatment of avascular necrosis of the femoral head (AVNFH) is based on invasive (e.g., core decompression) and non-invasive methods (e.g., hyperbaric oxygen therapy - HBO2). The purpose of the present study is to evaluate the effect of HBO2 on the quality of life (QoL) of patients with AVNFH. Methods: This was a prospective observational noncontrolled study of patients with AVNFH treated by HBO2. It was conducted, with the use of Steinberg scale, on 73 patients with AVNFH Stage I or II who were treated with HBO2. Patients' QoL was assessed with EuroQol-5D-5L (EQ), Harris Hip Score (mHHS), MAHORN (MHOT), and VAS, in three different phases: before HBO2; after the completion of the first phase (20 HBO2 sessions, up to two months); and after the completion of the second phase (20 HBO2 sessions, up to two months after the first phase). A reassessment was made on the completion of each phase. Ratings were also made after the completion of each phase, over the first five months of follow-up. Results: All 73 patients (67.1% males, 32.9% females, mean age: 40.34, SD ± 9.99) participated in the study. * Steinberg scale, mean EQ (F (1, 57) = 25.18, η² = .306 and F (1, 43) = 43.402, η² = .502); * mHHS (F (1, 61) = 67.13, η² = .524) and F (1, 43) = 31.84, η² = .425); * MHOT (F (1, 61) = 11.68, η² = .161) and F (1, 43) = 98.01, η² = .695); and * VAS (F (1, 53) = 24.11, η² = .313) and F (1, 39) = 45.61, η² = .539), improved between the first and second measurements and between the second and third measurement accordingly (p < .01). Conclusions: HBO2 treatment does not induce alteration of quality of life and is well tolerated and accepted by patients. [ABSTRACT FROM AUTHOR]

Objective: We reported the alveolar bone histology prior to dental extractions in cancer patients, who received bone‐targeting agents (BTA). Subjects and Methods: Fifty‐four patients were included. Patients underwent extractions, and bone biopsies were taken. Results: Extractions were performed due to pain, swelling, purulence, fistula, and numbness, not responding to treatment, in 40 patients (group A); extractions due to asymptomatic, non‐restorable teeth, were performed in 14 patients (group B). Complete alveolar jaw bone histological necrosis was observed in 28 of 40 (70%) patients of group A and none of group B (p <.001). The development of clinical osteonecrosis (MRON) was assessed in 44 patients; 10 patients, who were also treated with Low Level Laser Treatments‐LLLT, were excluded from this analysis, as the alternative therapies were a confounding factor. Twelve patients, with alveolar bone histological necrosis prior to extraction, developed medication‐related osteonecrosis of the jaw (MRONJ) compared with two patients with vital or mixed vital/non‐vital bone (p <.0007). BTAs >1 year and concurrent targeted therapy were also significantly associated with MRONJ (p =.016 and p =.050). Conclusion: Pain, swelling, purulence, fistula, and numbness were significantly associated with complete bone histological necrosis prior to extractions and increased MRONJ development. Research is justified to explore whether histological necrosis represents an early stage of osteonecrosis. [ABSTRACT FROM AUTHOR]

Reconstruction and repair of a complete bone fracture requires surgical drilling of bone in order to create holes which support easy insertion of screws. The objective of the research is to optimize kinematic parameters when drilling bone in order to avoid bone necrosis and increase the capacity of bones to retain the surgical screws. In literature there are presented attempts to measure the temperature of bones by introducing thermocouples into bone near the drill path which is not a satisfactory method. In this research it is proposed a new method for measuring temperature by means of a digital infrared thermometer oriented on bone surface where holes are made. We have drilled animal bones and represented the experimental curves of temperature for a wide range of kinematic parameters that are supposed to be used during orthopaedic operations. It is concluded speeds ranges that can be used when drilling bone holes, which ensures good cutting conditions and temperatures at a level which does not affect the quality of the assembly. [ABSTRACT FROM AUTHOR]

Summary: This study estimated the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults. Osteonecrosis was approximately 10 times more common than in previous studies. The strongest risk factors were dialysis, hip fracture, osteomyelitis, and organ transplantation, but only hip fractures could have contributed substantially to the disease burden. Introduction: The aim of this study was to estimate the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults and in a large number of risk groups in that cohort. Methods: In this retrospective cohort study, we included everyone who was aged 50 years or older and who was living in Sweden on 31 December 2005. We used Swedish national databases to collect data about prescription medication use, diagnosed medical conditions, and performed medical and surgical procedures. The study outcome was diagnosis of primary or secondary osteonecrosis at any skeletal site. The strength of risk factors was assessed using age- and sex-standardized incidence ratios (SIRs). Results: The study cohort comprised 3,338,463 adults. The 10-year risk of osteonecrosis was 0.4% (n = 13,425), and the incidence rate was 4.7 cases/10000 person-years (95% confidence interval [CI], 4.6 to 4.7 cases). The strongest risk factors for osteonecrosis were hip fracture (SIR, 7.98; 95% CI, 7.69–8.27), solid organ transplantation (SIR, 7.14; 95% CI, 5.59–8.99), dialysis (SIR, 6.65; 95% CI, 5.62–7.81), and osteomyelitis (SIR, 6.43; 95% CI, 5.70–7.23). A history of hip fracture was present in 21.7% of cases of osteonecrosis, but osteomyelitis, dialysis, and solid organ transplantation were present in only 0.5 to 2% of cases. Conclusions: Osteonecrosis was approximately 10 times more common than a small number of previous population-based studies have suggested. The strongest risk factors for osteonecrosis were dialysis, hip fracture, osteomyelitis, and solid organ transplantation, but only hip fractures could have contributed substantially to the disease burden. [ABSTRACT FROM AUTHOR]

Objective: Oral ulceration with bone sequestration (OUBS) describes a site‐specific intraoral ulcer that covers exposed, non‐vital bone in patients lacking any etiological factor known to induce osteonecrosis. We aimed to conduct a retrospective study of eight new cases of OUBS and review the literature. Subjects and Methods: This is a retrospective study of OUBS cases, diagnosed and managed during 2007–2017. Inclusion criteria were the presence of oral ulcer with exposed non‐vital bone at sites of bone prominence and the absence of any factor known to cause osteonecrosis. The English literature was reviewed on original OUBS cases. Results: Eight patients (5 males and 3 females, aged 27–75 years) were diagnosed with OUBS during years 2007–2017. Four cases involved the mandibular mylohyoid ridge, one a mandibular anterior exostosis and three the maxillary buccal/palatal exostoses. Exposed bone was removed under local anesthesia, resulting in complete healing in all cases. The literature review yielded 32 OUBS cases in the mandible. Conclusion: Oral ulceration with bone sequestration is a distinct, probably under‐reported rather than rare clinical entity that should be regarded the provisional diagnosis in case of an oral ulcer covering exposed, non‐vital bone at sites of bone prominence in patients lacking any etiological factor known to induce osteonecrosis. [ABSTRACT FROM AUTHOR]

A new entity called "implant periapical lesion" has recently been described. This lesion could be the result of, for example, bone overheating, implant overloading, presence of a preexisting infection or residual root fragments and foreign bodies in the bone, contamination of the implant, or implant placement in an infected maxillary sinus. This case report describes a titanium implant that was placed in the maxillary premolar region. A fenestration involving the middle portion of the implant was present. After 7 months, the apical portion of the implant showed radiolucency. This lesion rapidly increased in size and a vestibular fistula appeared. A systemic course of antibiotics was not successful, and the implant was then removed. The histologic examination showed the presence of necrotic bone inside the antirotational hole of the implant. The etiology of the implant failure in this instance could possibly be related to bone overheating associated with an excessive tightening of the implant and compression of the bone chips inside the apical hole, producing subsequent necrosis. [ABSTRACT FROM AUTHOR]

Background: Cooling is one of the main processes in bone temperature decrement, while drilling. this experiment was conducted for examination of alcohol effect as cooler in prevention of thermal necrosis. Methods: Bovine femur bone was considered as specimen and inclusions criteria for this study were: femur bone, cortical area and without bone periosteum. Drilling process was conducted by two types of k-wire- Trocar and Diamond, three speeds and three feed rates and in the time of march, 2016 in the place of university of Isfahan, Iran. Two type of thermometer- K-thermocouple and infrared thermometer- were used for temperature measurement, and all data were logged by data logger. Drilling processes were conducted by milling machine with ability of table movement for feed rate parameter. Method of alcohol usage in cooling was in form of conducting alcoholic gauze with k-wire while rotating. Results: Totally in the cases of trocar and diamond wires, while were cooled by alcohol, the risk of bone necrosis decreased about 44.44% and 66.66%. All temperature data were logged by changing parameters. maximum temperature, 94.5 °C, belonged to trocar wire in a non-cooling condition and after usage of cooler it decreased to 75 °C. In the usage of diamond wires, the maximum temperature was recorded 71 °C and the temperature while using alcohol was 51 °C. Diamond wire had better result in both conditions of cooling and no cooling, and this is related to geometric differences between two types of wires. Conclusion: Due to obtained data from examination, utilization alcohol can have an important influence on final bone temperature decreasing. The way of using alcohol was in the style of attrition soaked gauze onto wire while insertion.

Purpose: The aim of this study was to describe the clinical features of osteonecrosis (ON) in sickle cell disease (SCD) patients in Bahia, a Northeast state with the highest prevalence of the disease in Brazil.Methods: Between 2006 and 2017, 283 cases of osteonecrosis in SCD patients were enrolled to analyse the age at diagnosis, genotype, gender, pain, distribution of the lesions and disease staging. MRI and radiograph were obtained at the participation.Results: Of the 283 SCD cases, 120 (42.4%) were haemoglobin SS genotype while 163 (57.6%) were SC genotype. Two hundred and forty-six cases were bilateral and 37 were unilateral, with an average age at diagnosis of 33.7 (range 10-67) years. The most frequent identified ON site not only was the hip (74.6%), but also affected shoulder, knee and ankle. Most cases presented at early stage I (172, 60.8%) disease. No significant differences on the features of osteonecrosis were identified between haemoglobin SS and haemoglobin SC cases.Conclusions: Given the relatively high prevalence of bilateral osteonecrosis at early stages, painful symptoms and rather late age at diagnosis, SCD patients should have radiological examination of their joints more often in order to prevent severe functional disability and increase patient's life quality. [ABSTRACT FROM AUTHOR]